ORAU TEAM

Dose Reconstruction

Project for NIOSH

Oak Ridge Associated Universities I Dade Moeller I MJW Technical Services

Page 1 of 12

Document Title:

Dose Reconstruction Method for Chronic 

Lymphocytic Leukemia

Document Number: ORAUT-OTIB-0082

Revision: 00

Effective Date: 12/04/2012

Type of Document: OTIB

Supersedes: None

Subject Expert(s): Elizabeth M. Brackett, Matthew H. Smith, Elyse M. Thomas

Approval: Signature on File Approval Date: 12/03/2012

Elizabeth M Brackett, Document Owner

Concurrence: Signature on File Concurrence Date: 11/29/2012

John M. Byrne, Objective 1 Manager

Concurrence: Signature on File Concurrence Date: 11/28/2012

Edward F. Maher, Objective 3 Manager

Concurrence: Vickie S. Short Signature on File for Concurrence Date: 11/29/2012

Kate Kimpan, Project Director

Approval: Signature on File Approval Date: 12/04/2012

James W. Neton, Associate Director for Science

New Total Rewrite Revision Page Change

FOR DOCUMENTS MARKED AS A TOTAL REWRITE, REVISION, OR PAGE CHANGE, REPLACE THE PRIOR 

REVISION AND DISCARD / DESTROY ALL COPIES OF THE PRIOR REVISION.
Document No. ORAUT-OTIB-0082 Revision No. 00 Effective Date: 12/04/2012 Page 2 of 12

PUBLICATION RECORD

EFFECTIVE 

DATE

REVISION 

NUMBER DESCRIPTION

12/04/2012 00 New document initiated to describe the use of the chronic 

lymphocytic leukemia model and to provide guidance to dose 

reconstructors on its application. Incorporates formal internal and 

NIOSH review comments. Training required: As determined by the 

Objective Manager. Initiated by Elizabeth M. Brackett.
Document No. ORAUT-OTIB-0082 Revision No. 00 Effective Date: 12/04/2012 Page 3 of 12

TABLE OF CONTENTS

SECTION TITLE PAGE

Acronyms and Abbreviations ............................................................................................................... 4

1.0 Introduction .............................................................................................................................. 5

2.0 Purpose ................................................................................................................................... 5

3.0 General Model ......................................................................................................................... 5

3.1 Background .................................................................................................................. 5

3.2 Correspondence of Modeled Organs............................................................................ 6

4.0 Guidance ................................................................................................................................. 6

4.1 Medical X-Ray Dose..................................................................................................... 6

4.2 Internal Dose................................................................................................................ 6

4.2.1 Best Estimates.................................................................................................. 8

4.2.2 Integrated Modules for Bioassay Analysis......................................................... 8

4.2.3 Chronic Annual Dose Tool ................................................................................ 8

4.2.4 Type Super S Material ...................................................................................... 8

4.2.5 Tritium............................................................................................................... 8

4.2.6 Overestimates for Facilities with Air Sampling Programs .................................. 9

4.2.7 Radionuclide Chooser....................................................................................... 9

4.2.8 Environmental Doses........................................................................................ 9

4.2.9 Reactor Mixes................................................................................................... 9

4.3 External Dose............................................................................................................... 9

5.0 Attributions and Annotations .................................................................................................. 10

References ........................................................................................................................................ 11

LIST OF TABLES

TABLE TITLE PAGE

3-1 Correspondence of CLL model to ICRP-modeled organs......................................................... 7

4-1 Exposed skin fractions used to estimate skin dose................................................................... 8
Document No. ORAUT-OTIB-0082 Revision No. 00 Effective Date: 12/04/2012 Page 4 of 12

ACRONYMS AND ABBREVIATIONS

CAD Chronic Annual Dose (tool)

CLL chronic lymphocytic leukemia

DCF dose conversion factor

DHHS Department of Health and Human Services

DOE U.S. Department of Energy

EEOICPA Energy Employees Occupational Illness Compensation Program Act of 2000

ET2 extrathoracic region 2

FR Federal Register

HNM highest nonmetabolic organ

HTO tritiated water

ICRP International Commission on Radiological Protection

IMBA Integrated Modules for Bioassay Analysis

in. inch

IREP Interactive RadioEpidemiological Program

LLI lower large intestine

LN(ET) extrathoracic lymph nodes

LN(TH) thoracic lymph nodes

mrem millirem

NIOSH National Institute for Occupational Safety and Health

ORAU Oak Ridge Associated Universities

RBM red bone marrow

SI small intestine

SRDB Ref ID Site Research Database Reference Identification (number)

TIB technical information bulletin

U.S.C. United States Code

ULI upper large intestine

§ section or sections
Document No. ORAUT-OTIB-0082 Revision No. 00 Effective Date: 12/04/2012 Page 5 of 12

1.0 INTRODUCTION

Technical information bulletins (TIBs) are not official determinations made by the National Institute for 

Occupational Safety and Health (NIOSH) but are rather general working documents that provide 

historical background information and guidance to assist in the preparation of dose reconstructions at 

particular sites or categories of sites. They will be revised in the event additional relevant information 

is obtained about the affected site(s). TIBs may be used to assist NIOSH staff in the completion of 

individual dose reconstructions.

In this document, the word “facility” is used as a general term for an area, building, or group of 

buildings that served a specific purpose at a site. It does not necessarily connote an “atomic weapons 

employer facility” or a “Department of Energy (DOE) facility” as defined in the Energy Employees 

Occupational Illness Compensation Program Act of 2000 [42 U.S.C. § 7384l(5) and (12)].

In a notice of proposed rulemaking published in the Federal Register (FR) on March 21, 2011, the 

U.S. Department of Health and Human Services (DHHS) proposed to treat chronic lymphocytic 

leukemia (CLL) as a radiogenic cancer under the Energy Employees Occupational Illness 

Compensation Program Act of 2000 (EEOICPA) (76 FR 15268). On February 6, 2012, the final rule 

was published. Under the final rule, CLL will now be treated as being potentially caused by radiation 

and as potentially compensable under EEOICPA. This reverses an earlier decision by DHHS to 

exclude this cancer from consideration.

CLL originates in the B lymphocytes rather than in a well-defined organ as with other cancers. These 

lymphocytes are distributed throughout the lymph system and, as noted in Review, Synthesis, and 

Application of Information on the Human Lymphatic System to Radiation Dosimetry for Chronic 

Lymphocytic Leukemia (Apostoaei and Trabalka 2012), they can travel throughout the body and their 

inventories in various compartments of the body can change significantly with age, gender, health 

status and other factors. Estimation of dose to the cancer site for CLL cases requires the calculation 

of the radiation dose to this population of CLL precursor cells. This is more complex than dose 

assessment to other cancer sites because CLL precursor cells can be present in different 

compartments of the lymphatic system throughout the body, and these compartments can receive 

substantially different doses. Because the B lymphocyte population in a given organ is not constant, 

probability distributions are used in the assessment.

2.0 PURPOSE

A model was developed to determine a meaningful radiation dose for the assessment of radiological 

risk of CLL; complete details of this dosimetry model can be found in Apostoaei and Trabalka (2012).

This TIB provides guidance on the application of this model.

Attributions and annotations, indicated by bracketed callouts and used to identify the source, 

justification, or clarification of the associated information, are presented in Section 5.0.

3.0 GENERAL MODEL

3.1 BACKGROUND

Current information indicates that CLL is produced by transformation of mature, antigen-experienced 

B lymphocytes, possibly memory cells, potentially anywhere in the body (i.e., including but not 

restricted to the bone marrow). This situation complicates an assessment of the risk of developing 

CLL of radiogenic origin because definition of an appropriate target organ or tissue is problematic 

because radiation doses from internally deposited radionuclides and from some types of external 
Document No. ORAUT-OTIB-0082 Revision No. 00 Effective Date: 12/04/2012 Page 6 of 12

exposures can be very different at different locations within the body. B cells at different sites can 

thus receive markedly different doses.

In the development of the CLL dosimetric model, information was analyzed to derive compartmentspecific weights based on relative sizes of B-lymphocyte (more properly a B-cell precursor for CLL) 

pools to be used in estimating a weighted average radiation dose. Because of the variability and 

uncertainty in the distribution of these cells, probability distribution functions were assigned to the 

number of lymphocytes and to the fraction that represent B cells for each organ of interest. The final 

model consists of an average dose (and its uncertainty) obtained using weights based on the 

fractional distribution of B-lymphocyte precursors across 30 compartments for CLL.

3.2 CORRESPONDENCE OF MODELED ORGANS

There is not a complete one-to-one correspondence between the regions that are included in the 

estimates of inventories of CLL precursors and the organs and tissues for which radiation doses are 

estimated from International Commission on Radiological Protection (ICRP) models. Table 3-1 lists 

the corresponding organs to be assessed for each compartment of the CLL model. Where a direct 

correspondence was not available, a description of the CLL compartment and the assignments in

ORAUT-OTIB-0005, Internal Dosimetry Organ, External Dosimetry Organ, and IREP Model Selection 

by ICD-9 Code, were used to determine the appropriate organ (ORAUT 2011a).

4.0 GUIDANCE

4.1 MEDICAL X-RAY DOSE

Dose from medical X-ray exposure to each of the compartments comprising the CLL model in Table 

3-1 is determined in the usual way, as the product of the incident air kerma and the dose conversion 

factors (DCFs). Substitute DCFs are used for organs in the model without unique DCFs – as 

described in ORAUT-OTIB-0006, Dose Reconstruction from Occupational Medical X-Ray Procedures

(ORAUT 2011b) – and are shown in parentheses in Table 3-1. If two organs are listed in 

parentheses, the substitute DCF depends on the X-ray examination (typically chest or lumbar spine).

Each organ dose is then weighted by the fraction of CLL precursor cells in each organ according to 

the CLL model.

The organ dose assignment for CLL is the sum of the weighted organ doses after appropriately 

combining the uncertainty distributions using Monte Carlo methods, and accounting for the statistical 

correlation of the incident air kerma with the various organs. 

The skin dose from X-ray exposure for the purpose of CLL is a fraction of the entrance and exit dose

based on an estimate of the fraction of total skin exposed for poorly and properly collimated beams. 

The area of exposed skin is 3,074 cm2 (14- by 17-in. on each of the entrance and exit sides) for 

properly collimated beams, and an area twice this size (6,148 cm2

) for poorly collimated beams 

(ORAUT-OTIB-0006, ORAUT 2011b). The total skin area for females (16,000 cm2

) from ORAUTOTIB-0017, Interpretation of Dosimetry Data for Assignment of Shallow Dose (ORAUT 2005a) will be 

used to calculate the skin dose fraction because it yields a slightly higher fractional result. It is 

assumed that all of the area of the beam (both poorly and properly collimated) is the same as the area 

of exposed skin. Table 4-1 provides the exposed skin fractions for estimating the skin dose.

4.2 INTERNAL DOSE

For internal dose calculation, the B lymphocytes compartments correspond to 25 organs, so doses to 

all 25 of these organs must be calculated to determine the CLL dose to be entered into the Interactive 

RadioEpidemiological Program (IREP). However, one of these corresponds to the highest 
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nonmetabolic organ (HNM), which can be one of several organs depending on the particular 

circumstances of the exposure. Bone surface, brain, gall bladder, and heart wall are possible HNM 

organs but are not included in the internal organ correspondence list. Therefore, a total of 28 organs 

must be assessed for the internal dose determination.

As a general rule, assessment of the CLL internal dose is equivalent to assessing a claim with 

cancers of 28 different organs. However, this can be a complicated process and at a minimum is very 

lengthy, so specific issues associated with this calculation are addressed here. Although the CLL tool 

is mentioned, details of its use are not included here; these are addressed in the tool user guide.

Table 3-1. Correspondence of CLL model to ICRP-modeled organs.

Compartment of CLL

dosimetry model X-ray dose organa Internal dose organ External dose organ

Lymph nodes

Extrathoracic Thyroid LN(ET) Thyroid

Thoracic Lung LN(TH) Lung

Remainder Ovaries HNMb Stomachc

Spleen Spleen (lung or ovaries) Spleen Stomachc

Peyer's Patches Colon (ovaries) SI Stomachc

Thymus Thymus (lung) Thymus Thymus

Red bone marrow Bone marrow RBM RBM

Tonsils Esophagus (lung) LN(ET) Esophagus

Blood Remainder HNMb Stomachc

Intestinal mucosa

Small intestinal wall Ovary SI Stomachc

Upper intestinal wall Colon (ovaries) ULI Colonc

Lower large intestinal wall Colon (ovaries) LLI Colonc

Respiratory mucosa

Extrathoracic airways Esophagus (lung) ET2 Esophagus

Lung Lung Lung Lung

Skin Skin Skin Skin

Liver Liver (lung or ovary) Liver Liverc

Vermiform appendix Colon (Ovaries) ULI Colonc

Residual soft tissue

Muscle Remainder Muscle Remainder

Breast Breast Breast Breast

Kidneys Remainder Kidney Liverc

ST wall Stomach (lung or ovaries) Stomach Stomachc

Pancreas Pancreas (lung or ovaries) Pancreas Stomachc

Uterus Uterus Uterus Uterusc

Urinary bladder wall Urinary bladder (ovaries) Bladder Bladderc

Esophagus Esophagus (lung) Esophagus Esophagus

Testes Testes Testes Testesc

Thyroid Thyroid Thyroid Thyroid

Prostate Prostate (ovaries) HNMb Bladderc

Adrenals Remainder Adrenals Remainder

Ovaries Ovaries Ovaries Ovariesc

a. An organ in parentheses after the listed organ indicates the substitute organ DCF to be used to assess the dose to the 

listed organ. If there are two organs in parentheses, the substitute DCF depends on the X-ray examination (typically 

chest or lumbar spine).

b. See ORAUT-OTIB-0060, Internal Dose Reconstruction, (ORAUT 2007a) for guidance on selection.

c. Organs that could require application of a glovebox geometry correction factor from DCAS-TIB-0010, Best Estimate 

External Dose Reconstruction for Glovebox Workers (NIOSH 2011) or the geometry correction factor from DCAS-TIB0013, Selected Geometric ExposureScenario Considerations for External Dose Reconstruction at Uranium Facilities

(NIOSH 2010).
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Table 4-1. Exposed skin fractions used to estimate skin dosea,b

Exposure type Estimated skin dose

Properly collimated beam (entrance + exit skin dose) (0.19)

Poorly collimated beam (entrance + exit skin dose) (0.38)

a. Exposure area is 3,074 cm2 (14- by 17-in. on each of the entrance and exit sides) for properly collimated 

beams, and twice this area (6,148 cm2

) for poorly collimated beams (ORAUT (2011b)).

b. The total skin area for females (16,000 cm2

) used to calculate the skin dose fraction ORAUT (2005a).

4.2.1 Best Estimates 

When a best estimate is needed, parameters must be consistent across all organs. For example, the 

material type for a given intake of a radionuclide must be the same for all organs. Note that this does 

not preclude the assignment of multiple material types for a given nuclide. This can happen when one 

type is maximizing for a fitted dose while a different type is more favorable to the claimant for the 

missed dose. However, a consistent material type must be used across all organs for the fitted doses 

and similarly, a consistent material type must be used for the missed dose calculation for all organs.

When comparing missed versus fitted dose, annual doses should be compared after running the CLL 

tool rather than comparing the missed vs. fitted annual doses to the individual organs before the 

values are input to the CLL tool.

4.2.2 Integrated Modules for Bioassay Analysis

The Integrated Modules for Bioassay Analysis (IMBA) calculates all organ doses simultaneously. To 

generate a report that includes doses for all organs, click the Select all option on the Equivalent 

Doses page. The CLL tool will import all organs necessary for performing the dose calculation.

4.2.3 Chronic Annual Dose Tool

The Chronic Annual Dose (CAD) Tool has been modified to create files for all relevant organs. A 

separate file is created for each organ.

4.2.4 Type Super S Material

Adjustment factors from ORAUT-OTIB-0049, Estimating Doses for Plutonium Strongly Retained in the 

Lung (ORAUT 2010) for Type super S material are organ dependent, so the doses to each organ 

must be adjusted before entry in the CLL tool. The dose to all organs from Type S plutonium must 

first be assessed, using a consistent set of assumptions for all organs.

4.2.5 Tritium

Dose from tritiated water (HTO) is most often calculated using the tritium tool (Tritium Doses from 

Urine Data Workbook) as documented in ORAUT-OTIB-0011, Technical Information Bulletin: Tritium 

Calculated and Missed Dose Estimates (ORAUT 2004) because IMBA will not directly calculate the 

dose from measured HTO in urine samples. The tritium tool generates only a single list of doses, 

which are applicable to all organs. These doses must be entered into the CLL tool for all relevant 

organs.

IMBA is used to assess doses from stable metal tritides (see ORAUT-OTIB-0066, Calculation of Dose 

from Intakes of Special Tritium Compounds, ORAUT 2007b), so Section 4.2.1 guidance can be 

followed.
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4.2.6 Overestimates for Facilities with Air Sampling Programs

This overestimating method is applicable to CLL cases, as allowed by ORAUT-OTIB-0018, Internal 

Dose Overestimates for Facilities with Air Sampling Programs (ORAUT 2005b). Each organ in the 

CLL model must be assessed.

4.2.7 Radionuclide Chooser

The Chooser tool is used to determine the radionuclide and material type combination that is most 

favorable to the claimant from a whole-body count where many nuclides are reported. In the case of 

CLL, this information is necessary for the 28 organs of interest; Radionuclide Chooser can be used to 

determine the maximizing radionuclide and type combination for each of these organs. Once this list 

is generated, IMBA is run for each of these nuclides for input to the CLL tool.

4.2.8 Environmental Doses

The environmental tool can be used for each organ of interest; one file for each organ in the CLL 

model must be generated for input to the CLL tool. Although this tool selects the maximizing material 

type for each organ and these types are not necessarily the same across all organs, environmental 

doses are typically relatively small so this can be used for a best estimate.

4.2.9 Reactor Mixes

The tool implementing ORAUT-OTIB-0054, Fission and Activation Product Assignment for Internal 

Dose-Related Gross Beta and Gross Gamma Analyses (ORAUT 2007c), selects the maximizing 

material type for each radionuclide in the mixture based on the organ of interest. If a best estimate is 

not needed, the files that are generated for each organ of the CLL model can be used as is. As noted 

in Section 4.2.1, the material type for a given radionuclide must be the same for all organs when a 

best estimate is needed.

4.3 EXTERNAL DOSE

For external dose calculation, the B lymphocytes compartments correspond to 15 organs as listed in 

Table 3-1. These organs were selected based on the availability of data for DCFs from OCAS-IG001, External Dose Reconstruction Implementation Guideline (NIOSH 2007) and surrogate organ 

guidance in ORAUT-OTIB-0005 (ORAUT 2011a).

In order to properly account for the correlation of external dose between dosimeter measurements 

and the individual organs listed in Table 3-1, a special dose conversion factor has been derived and is 

used to determine the dose to the appropriate CLL compartments. This blended CLL DCF – as 

described in DCAS-RPT-004, Chronic Lymphocytic Leukemia Dose Conversion Factors - is 

comprised of the weighted fractions of the DCF values associated with the 15 organs listed in Table 3-

1 (NIOSH 2012). Dose should be calculated using Monte Carlo techniques to combine distributions 

for measured (or missed) dose, the blended CLL DCF distribution, and distributions for factors such 

as neutron-to-photon ratios. Descriptions of the applications of Monte Carlo methods for external 

dose are outlined in OCAS-IG-001 (NIOSH 2007) and ORAUT-OTIB-0012, Technical Information 

Bulletin: Monte Carlo Methods for Dose Uncertainty Calculations (ORAUT 2005c).

Organs that could require application of a geometry correction factor due to glovebox work as 

described in DCAS-TIB-0010, Best Estimate External Dose Reconstruction for Glovebox Workers

(NIOSH 2011) - or due to work at uranium facilities as described in DCAS-TIB-0013, Selected 

Geometric Exposure Scenario Considerations for External Dose Reconstruction at Uranium Facilities

(NIOSH 2010) - are identified in Table 3-1. In situations where a geometry correction factor is 
Document No. ORAUT-OTIB-0082 Revision No. 00 Effective Date: 12/04/2012 Page 10 of 12

needed, a blended CLL DCF incorporating the factor (either as a distribution or as a constant) will be 

used (NIOSH 2012). 

Dose assignment to the skin – both penetrating and nonpenetrating – is done in accordance with the 

guidance in ORAUT-OTIB-0017 (ORAUT 2005a). Shallow dose (typically open window-shallow) 

should be assigned to the skin organ without any transmission correction factors due to the small 

fraction (0.064%) of dose that is assigned to the skin compartment in the CLL model. In addition, due 

to the small area of skin that is associated with extremity dose (<5% of skin area is associated with 

the hands), the overall dose to the skin from extremity dose is likely to be ≤1 mrem (i.e., over 31 rem 

of extremity dose would be needed to equal 1 mrem of dose to skin-extremities). Therefore, extremity 

dose is not included in the model implementation. Similarly, dose from skin contamination incidents –

unless it is a case of whole-body or large area contamination – should not be added to the skin dose. 

Situations that involve large area contamination can be addressed using the guidance in ORAUTOTIB-0017 (ORAUT 2005a).

5.0 ATTRIBUTIONS AND ANNOTATIONS

All information requiring identification was addressed via references integrated into the reference 

section of this document.
Document No. ORAUT-OTIB-0082 Revision No. 00 Effective Date: 12/04/2012 Page 11 of 12

REFERENCES

Apostoaei, A. I., and J. R. Trabalka, 2012, Review, Synthesis, and Application of Information on the 

Human Lymphatic System to Radiation Dosimetry for Chronic Lymphocytic Leukemia, SENES 

Oak Ridge, Oak Ridge, Tennessee, March. [SRDB Ref ID: 119510]

NIOSH (National Institute for Occupational Safety and Health), 2007, External Dose Reconstruction 

Implementation Guideline, OCAS-IG-001, Rev. 3, Office of Compensation Analysis and 

Support, Cincinnati, Ohio, November 21.

NIOSH (National Institute for Occupational Safety and Health), 2010, Selected Geometric Exposure 

Scenario Considerations for External Dose Reconstruction at Uranium Facilities, DCAS-TIB0013, Rev. 1, Division of Compensation Analysis and Support, Cincinnati, Ohio, November 

23.

NIOSH (National Institute for Occupational Safety and Health), 2011, Best Estimate External Dose 

Reconstruction for Glovebox Workers, DCAS-TIB-0010, Rev. 4, Division of Compensation 

Analysis and Support, Cincinnati, Ohio, November 28.

NIOSH (National Institute for Occupational Safety and Health), 2012, Chronic Lymphocytic Leukemia

Dose Conversion Factors, DCAS-RPT-004, Rev. 0, Division of Compensation Analysis and 

Support, Cincinnati, Ohio, Month Date.

ORAUT (Oak Ridge Associated Universities Team), 2004, Technical Information Bulletin: Tritium 

Calculated and Missed Dose Estimates, ORAUT-OTIB-0011, Rev. 00, Oak Ridge, Tennessee, 

June 29.

ORAUT (Oak Ridge Associated Universities Team), 2005a, Interpretation of Dosimetry Data for 

Assignment of Shallow Dose, ORAUT-OTIB-0017, Rev. 01, Oak Ridge, Tennessee, October 

11.

ORAUT (Oak Ridge Associated Universities Team), 2005b, Internal Dose Overestimates for Facilities 

with Air Sampling Programs, ORAUT-OTIB-0018, Rev. 01, Oak Ridge, Tennessee, August 9.

ORAUT (Oak Ridge Associated Universities Team), 2005c, Technical Information Bulletin: Monte 

Carlo Methods for Dose Uncertainty Calculations, ORAUT-OTIB-0012, Rev. 00, Oak Ridge, 

Tennessee, February 14.

ORAUT (Oak Ridge Associated Universities Team), 2007a, Internal Dose Reconstruction, ORAUTOTIB-0060, Rev. 00, Oak Ridge, Tennessee, February 6.

ORAUT (Oak Ridge Associated Universities Team), 2007b, Calculation of Dose from Intakes of 

Special Tritium Compounds, ORAUT-OTIB-0066, Rev. 00, Oak Ridge, Tennessee, April 26.

ORAUT (Oak Ridge Associated Universities Team), 2007c, Fission and Activation Product 

Assignment for Internal Dose-Related Gross Beta and Gross Gamma Analyses, ORAUTOTIB-0054, Rev. 00 PC-1, Oak Ridge, Tennessee, November 19.

ORAUT (Oak Ridge Associated Universities Team), 2010, Estimating Doses for Plutonium Strongly 

Retained in the Lung, ORAUT-OTIB-0049, Rev. 01 PC-2, Oak Ridge, Tennessee, November 

29.
Document No. ORAUT-OTIB-0082 Revision No. 00 Effective Date: 12/04/2012 Page 12 of 12

ORAUT (Oak Ridge Associated Universities Team), 2011a, Internal Dosimetry Organ, External 

Dosimetry Organ, and IREP Model Selection by ICD-9 Code, ORAUT-OTIB-0005, Rev. 04, 

Oak Ridge, Tennessee, April 18.

ORAUT (Oak Ridge Associated Universities Team), 2011b, Dose Reconstruction from Occupational 

Medical X-Ray Procedures, ORAUT-OTIB-0006, Rev. 04, Oak Ridge, Tennessee, June 20.